Diameter of the External Urethral Sphincter as a Predictor of Detrusor-Sphincter Incoordination in Children: Comparative Study of Voiding Cystourethrography

Abstract

Underlying urological disease was primary vesicoureteral reflux in 57, congenital hydronephrosis in 9, urinary tract infection in 6, ureteral anomalies in 11, and others in 13.For the determination of EUSD in a given VCUG, EUSD was measured in consecutive films and the widest EUSD was chosen. (Part 2) Forty-three children with suspected voiding dysfunction underwent VCUG and sphincter electromyography (EUS-EMG). The findings of EUS-EMG were comparatively analyzed with EUSD.Results: (Part 1) Age-dependent increase in EUSD was seen in children with normal voiding function. EUSD (mm) was formulated as 0.166 x age (years) + 4.31 for boys (p=0.0001, r=0.374), and 0.222 x age (years) + 2.73 for girls (p<0.0001, r=0.595). Overall incidence of EUSD less than 3 mm was only 4% (8/200). (Part 2) EUS-EMG documented detrusor-sphincter incoordination in 15 children (35%). When we defined EUSD less than 3mm as a cut-off value for predicting detrusor-sphincter incoordination, the sensitivity, specificity, positive and negative predictive values were 93%, 89%, 82% and 96%, respectively.Conclusions: EUSD has a satisfactory sensitivity and specificity as a predictor of 2 detrusor-sphincter incoordination in children. Thus, simple measurement of EUSD on VCUG should be recommended in children with suspected voiding dysfunction before employing rather invasive urodynamic study.3

Impact of bowel management in alleviating symptoms of urinary incontinence in patients with spina bifida associated with overactive bladder and detrusor sphincter dyssynergia

“…The presence of OAB and DSD was also an inclusion criterion. OAB was defined as echosonographically determined bladder wall thickness >5 mm [7,8] and voiding cysto-urethrography (VCUG) findings of bladder wall irregularity, elongation of bladder shape, filling of the posterior urethra and external urethral sphincter inner diameter <3 mm [9,10]. DSD was confirmed based on uroflowmetry with patch electromyography.…”